Scoliosis: Dr. Bitan Answers Your Top Questions

A conversation with Fabien Bitan, MD, Orthopedic Spine Surgeon with the Atlantic Spine Center, West Orange, New Jersey.

What is scoliosis?

Dr. Bitan: Scoliosis is a disorder in which the normally straight vertical line of the spine curves sideways. The curve is often S-shaped or C-shaped. An estimated 2% to 3% of the U.S. population (6 to 9 million people) have scoliosis.

Dr. Bitan: The most common type of scoliosis, called idiopathic scoliosis, develops in children between the ages of 10 to 15. Idiopathic means there is no known cause. Most types of scoliosis are more common in girls.

Scoliosis can run in families. About 30% percent of teens who develop scoliosis have a family history of the disorder. If a child has a parent or sibling with scoliosis, they should have regular medical checkups to see if they are developing a spine curve. Parents often ask me if there is anything they could have done to prevent their child’s scoliosis, and the answer is no.

What are the signs and symptoms of scoliosis?

Dr. Bitan: One shoulder or shoulder blade is higher or more prominent than the other One hip is higher than the other The head appears to be off-center When the child bends forward, one side of the back is higher than the other The spine curve often starts gradually, and then becomes more noticeable when a child has a growth spurt and the curve becomes more severe.

How is scoliosis diagnosed?

Dr. Bitan: Scoliosis is diagnosed through a medical and family history, physical exam and X-ray, which shows how severe the curve is, as well as its location, shape and pattern.

Do all cases of scoliosis need treatment?

Dr. Bitan: A person with milder curves may not need treatment, but does need to visit their doctor every four to six months for exams to make sure the curvature is not getting worse. A doctor will determine if treatment is needed based on the person’s age, how much more she is likely to grow, the degree and pattern of the curve, and the type of scoliosis.

What happens if scoliosis goes untreated?

Dr. Bitan: If a teen has a 50° or greater curve in their spine, the risk is fairly high that in the next 10 to 20 years, the scoliosis will continue to progress during adulthood. Scoliosis can progress an average of 1° a year. That means that a teen with a 50° curve could end up with a 70° curve by the time they are in their mid-30s. That is quite a noticeable curve. In addition to the issue of appearance, a severe curve can cause arthritis and back pain as you age. As a curve gets to 90° or 100°, the rib cage may press against the lungs and heart, making it more difficult to breathe and harder for the heart to pump.

Does the age at which treatment starts affect the outcome?

Dr. Bitan: Yes. The earlier you catch it, the better the outcome of treatment. If you catch a case of scoliosis that requires treatment at age 11, a child often can wear a brace to correct the spine curve and can avoid the need for surgery. For girls, treatment outcomes are best when started before the girl is fully physically mature. Once a girl has started to menstruate, brace treatment is less effective, and surgery may be needed.

What is the biggest misconception about scoliosis?

Dr. Bitan: Several decades ago, a child who needed surgery for scoliosis would have to remain in a body cast for a year, and then spend another year wearing a brace. Parents remember this, and are worried their child might need to endure the same treatment. Fortunately, treatment has advanced greatly in the last 20 years. Surgery for scoliosis is still an invasive procedure, but a body cast is no longer needed, and recovery is much quicker than in years past.

When is a brace used to treat scoliosis?

Dr. Bitan: The doctor may recommend wearing a spinal brace for children who are still growing and have a moderate spine curve (between 25° and 40°). Some braces are worn all the time (except for bathing) and some are worn only at night. Children who wear braces can usually participate in most activities and have few restrictions (See Why do I have to Wear a Brace).

There are different types of braces. The particular type of brace that is best depends on the type of curve they have and where it is. In some younger children with a smaller curve, wearing a brace full-time for a year may correct the curve completely. If an X-ray shows that after a year of wearing a full-time brace the spine is straight, the patient can switch to a part-time brace for another year. If an X-ray shows the spine is still straight after that, the doctor may recommend going without the brace, but continuing to monitor the spine.

When is surgery recommended for scolioisis?

Dr. Bitan: Surgery is often used to correct the curve and stabilize the spine when the curve is severe (more than 40° to 50°), bracing has not been effective in halting the progression of scoliosis, and the patient is still growing.

What happens during scoliosis surgery?

Dr. Bitan: The surgery typically lasts four or five hours. The surgeon opens the back and exposes the spine, and fuses several vertebrae (bones) in the spine. Pieces of bone or a bone-like material are placed between the vertebrae. Metal rods, hooks, screws or wires typically hold that part of the spine straight and still while the old and new bone material fuses together.

What are the risks of surgery?

Dr. Bitan: Complications of spinal surgery may include bleeding, infection, pain or nerve damage. Rarely, the bone fails to heal and another surgery may be needed. A very rare complication is paralysis. I tell patients the risk is about as great as the risk that your plane will crash when you go on vacation. While in the past, patients needed a blood transfusion, we now use special techniques to avoid bleeding. Most idiopathic scoliosis surgeries I perform do not require a transfusion.

What is recovery from surgery like?

Dr. Bitan: The day after surgery, patients, with the help of a physical therapist, get out of bed and start walking. Every day she walks a little more, and in five days on average, she can go home. Six to eight weeks after surgery, patients often are able to start swimming or going to the gym. I recommend they start with activities that involve cardio fitness rather than muscle fitness, in order to give the muscles more time to recuperate. How soon someone can go back to sports is decided on a case-by-case basis. In general, I recommend they wait a few months, rather than risking injuring themselves and facing complications. By six months after surgery, all patients should be back to all of their pre-surgery activities.

Can alternative treatments, such as yoga, chiropractic treatment, massage or physical therapy, help treat scoliosis?

Dr. Bitan: There is no scientific evidence that shows that these treatments can reverse or stabilize scoliosis. Physical therapy can be helpful before and after scoliosis surgery in terms of recovery and preventing complications, but it will not correct the curve itself. Exercise, while it does not prevent scoliosis from getting worse, helps people with the condition stay physically fit and keeps bones strong.

Are there any long-term consequences of surgery for girls?

Dr. Bitan: Parents often ask me if scoliosis surgery will affect a girl’s future ability to have children. The surgery will not affect her ability to have children, although she may not be able to have an epidural pain injection, which goes into the spine. As her children grow, she should have them checked regularly for signs of scoliosis, since the condition can run in families.

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